More Lessons Learned

I've been monitoring my blood glucose levels for a while now, and a few things have become apparent to me.

• Carbohydrates are trying to kill me.
• Dawn phenomenon sucks.
• Exercise can do some wacky non-intuitive stuff.
• It is going to take me a while to get a handle on this whole thing.

So, to recap, this class I went to that was supposed to teach me how to manage my type II diabetes was almost entirely useless, and most of the advice was counterproductive. At this point, I see only two good things to have come out of going to the class: a) I'm now monitoring my BG on a regular basis (I have test 14 times thus far today, with at least another test before I go to bed), and b) I have become extremely curious about this disease (condition?).

Here are some of the things I "learned":

• Diabetes is a progressive disease and as time goes by, I can expect it to get worse and for additional complications to come up.
• If I can make sure I'm between 70 and 120 before a meal and be less than 180 after meals, I will be in good control.
• I need lots of of carbohydrates (to the tune of 275 grams per day) including lots of starch because they contain essential nutrients.
• I need to make sure to eat low-fat foods, because dietary fat causes heart disease.
• I need to make sure to keep my dietary cholesterol low, because dietary cholesterol causes heart disease.
• Sulfonylureas are super awesome because they cause your pancreas to excrete insulin, which will lower your blood glucose.

That's not all, but it's enough. Here's the deal, though: every one of those things is just wrong.

Fact: constant high blood glucose levels is the cause of every diabetic complication. Normalize the blood glucose, and there are no further complications, and in a lot of cases, existing complications can be reversed. Normalizing isn't a _cure_ for diabetes, but it can certainly cause one to become asymptomatic.

So, how do you normalize blood glucose levels? It's actually pretty simple, and the answer isn't a high-carbohydrate low-fat diet.

Fact: there's no such thing as an "essential carbohydrate". That's right, you don't need them at all. Your body can run entirely on protein and fats. Here's another fact: carbohydrates cause blood glucose levels to rise rapidly; proteins and fat do not do this. I know this because I've verified it with my glucose meter.

So, what is "normalized"? Well, regular non-diabetic people generally have a blood glucose level of about 83. So, if I want normal blood sugars, 83 seems like a pretty good target, and the ideal is for it to just stay at 83 all the time; upon waking, before meals, after meals and so forth. If my pancreas, liver and muscles all acted normally, this would not be a problem. But, my endocrine system is messed up, so I have to give it some help in the form of a low-carbohydrate high-fat diet, lots of anaerobic exercise and oral medications.

How does one normalize their blood sugar? It's actually pretty easy (to understand, at least):

• Eat a low-carbohydrate diet.
• Exercise regularly
• If necessary, take metformin (aka Glucophage)

The purpose of the low-carbohydrate diet is pretty straightforward. If I take most of the carbs the ADA would like me to eat and replace those calories with fat calories, my blood sugar simply cannot have those high spikes (at least not from eating; the "dawn phenomenon" is another thing). The reason you replace the carbs with fat is because you still need a particular number of calories to fuel your various activities each day; if you just cut the carbs down and do nothing else, your body is not going to be very happy with you and other nasty metabolic things will happen, which you do not want.

Exercise does a couple of things. First, it burns blood glucose, which lowers the levels; second, and probably more importantly, it helps reduce my insulin resistance, which means that what insulin I do produce is much more effective at getting my muscles to accept the glucose running around in my blood. This is good, because the other choice is for fat cells to accept it, and that will just make me fatter, which is not at all what I want.

I have to be careful with the exercise, though. Super-vigorous exercise can cause you to release "fight-or-flight" hormones, and these hormones signal the liver to create some glucose posthaste so you can outrun the bear that's after you. I've seen a rise of over 40 points just from going too hard at class. Interestingly, my daily walks to and from work from the bus are probably the most helpful right now in controlling my BG.

Metformin is one of the oldest and most useful drugs for treating diabetics that still produce insulin, which means most type IIs, and a few Type Is. It does two things:

• Lowers insulin resistance, causing muscles to allow the insulin to let the glucose in
• Signals the kidney to slow down or stop gluconeogenesis (creating glucose from proteins stored in the form of glucagon)

This is very helpful, because many Type IIs (including me) actually produce insulin, they're just insulin resistant which means that the insulin cannot do its job. The other major class of oral drugs (sulfonylureas) instead cause your pancreas to crank out more insulin, which can also work, but also causes accelerated beta cell death (those are the ones that make insulin) which is not something I'm interested in.

But, what about all that fat? Well, it's fine, if I'm exercising regularly, it gets turned into fuel as I go about my daily routine. It has the added bonus of making me feel satisfied after meals, and also, calorie-for-calorie, it takes up less room in my stomach, and if I can feel full without being stuffed with food, that helps keep my blood glucose levels from spiking, too. Contrary to popular belief, dietary fat doesn't get turned into fat, and dietary cholesterol doesn't get turned into that stuff that clogs your arteries. So, yay, eggs! (Eggs are an awesome source of protein, yolks and all).

I've been using an application called "SugarStats" to track my vital diabetes statistics, and I can tell you that, for me at least, the low-carb diet really is the thing. From the week ending June 10th, 2012, my morning average BG was 136, and my daily average was 128, with a high of 168 and a low of 100. I've been low-carbing since then, and this last week, my morning average BG was 119 and my daily average was 114 with a high of 138 and a low of 79.

I've also learned a couple of interesting things:

• I have "dawn phenomenon", meaning that my liver likes to make glucose in the early morning hours (starting around 4am, it looks like), which is also the time during which I am most insulin-resistant; overnight, I can generally expect it to rise 30 points between bedtime and waking up at 5am. This bites, because it's pretty consistent, and there doesn't seem to do anything diet-wise that can change it, at least in the short term.
• My morning walk of 1.2 miles from the bus to the work will lower me around 15-20 points. This is awesome, because I can get to a decent number before breakfast. However, it looks like the liver doesn't finish up dumping glucose until around 8:30am or so, because when I'm done walking, I see a low, then I continue to see a rise from that point, even if I eat no carbohydrates, and even if I eat nothing.
• It matters greatly what my BG level is when I go to bed. With the dawn phenomenon, if I start at 100 at bedtime, I'm going to be 130 when I wake up. so, I need to actively try to lower it at night to something like 80, so I can wake up at 110 or so.

My next visit to the doctor is going to be interesting; I'm expecting to see a drop in my HgA1C (the "3-month blood sugar" test).

You're probably wondering just what it is I eat now. It's actually not too bad, and pretty normal.

For breakfast (on work days), I have 2 eggs over hard, and 2 slices of bacon. Oh, and coffee, lots of coffee. On the weekend, it's still a little weird, but I'm going to find something similar.

For lunch (again, work days), I have 4-6 oz. of some kind of protein, and vegetables. Today, I had some grilled pork chops, and a nice salad. I use olives and nuts to add most of the fat, but sometimes I'll have bratwursts and sauerkraut instead. In any case, I do not eat until I'm full any more, I just eat the pre-calculated amount, and stop. And, I'm not hungry.

For dinner, it's usually a lot like lunch, except I'll probably have a couple of kinds of vegetables, and I'll probably have one of those Wasa styrofoam crackers with some cream cheese. It's still not a lot, because I've got this taekwondo stuff I need to do without yarfing all over Ms. Murphy's floor. :)

On most nights, I have a small snack before bedtime, just to keep the BG from falling too far in the night. If I let it fall too far, I'll get the old double-cross: dawn phenomenon + rebound high, where I'll end up going up 60 or more points overnight, which is not what I want.

There are things I just cannot eat any more, at all. No pasta, no rice, no bread, at least not in any portion which would be useful. I can get away with one spaghetti noodle, but who wants just one spaghetti noodle? When we go for sushi, I get sashimi now; just as good, and I never really cared about the rice that much anyway. Generally, I have to be very careful at restaurants because even if I eat the right things, I can still easily eat too much, which causes another thing called "chinese restaurant syndrome". It turns out that if you eat too much of anything, it causes a chain reaction that ends up dumping a lot of extra glucose into your system. As in, you could fill your stomach with sawdust, which is not digestible (and I don't recommend it for any purpose), your BG will rise, and if you're insulin resistant like me, it'l stay risen for quite a while, which is not good.

For treats, I eat the occasional tiny ice cream, and dark chocolate in small quantities doesn't seem to hurt much. So, all in all, it's just not that bad.

Oh, and by the way, I've also lost almost 30 pounds with the new low-carb diet. So, personal victory for me.